肺结核患者121例抗结核药物引起肝损害的临床分析

Clinical analysis of 121 cases of drug-induced liver injury by antituberculosis drug

目的探讨应用抗结核药物所致药物性肝损害的临床特点、预防和治疗措施。方法我院1152例结核患者中,抗结核药物治疗后出现121例药物性肝损害,分析肝损害出现的年龄、初复治情况、乙肝病毒感染关系以及治疗方法。结果接受抗结核治疗的患者中,≥60岁的老龄、复治及乙肝病毒表面抗原(HBsAg)(+)患者出现肝损害的发生率较<60岁、初治及HBsAg(-)患者高,差异具有统计学意义(P<0.001)。给予保肝、降酶等治疗后,肝功能恢复效果好。结论对高龄、复治及乙肝病毒感染肺结核患者,是抗结核药物致肝损害的高危人群,应密切观察肝功能情况,早发现、早预防、早治疗肝损害,以利于顺利完成抗结核化疗疗程。

Objective To investigate the clinical features, prevention and therapeutic measures of drug - induced liver injury by antitu- berculosis drug. Methods In 1 152 cases of tuberculosis patients in our hospital, 121 cases had antituberculosis drug - induced liver injury. Drug - induced liver injury and its relation to age, initial treatment, retreatment and HBe infection were analyzed. Results The incidence of drug - in- duced liver injury was higher in patients ≥60 - years - old, HBeAg ＋ and undergoing retreatment than that in patients 〈 60 - years - old, HBeAg - and undergoing initial treatment （ P 〈0. 001 ）. The treatments of protecting liver, falling enzyme had good efficacy for recovering he- patic function. Conclusion Elderly, retreatment and HBe ＋ are high - risk factors for drug - induced liver injury by antituberculosis drugs in tu- berculosis patients. The hepatic function should be closely monitored in order to detect and treat drug - induced liver drug early and help patients complete antituberculosis chemotherapy.